Jaundice Flashcards
When is clinical jaundice often visible?
> 35 micomols/L
Normal - 3-20
What drugs can cause pre hepatic jaundice?
Methyldopa, sulfasalazine (5 ASA)
What haemolytic anaemias can cause pre hepatic jaundice?
Sickle cell
THalassaemia
Herediatary spherocytosis
Glucose-6-phosphate dehydrogenase deficiency
Haemolytic uraemic syndrome
What are haemolytic uraemic syndrome?
Group of blood disroders characterised by low red blood cells, acute kidney failure, and low platelets. Initial symptoms typically include bloody diarrhea, fever, vomiting, and weakness
What are haemolytic uraemic syndrome? Initial symptoms?
Group of blood disroders characterised by low red blood cells, acute kidney failure, and low platelets. Initial symptoms typically include bloody diarrhea, fever, vomiting, and weakness
What causes Gilbert syndrome?
Autosomal recessive condition causing defective bilirubin conjugation due to deficiency of UDP glucuronyl transferase
Gilbert vs Criggler najjar syndrome cause
Gilbert - mutation in promoter seuquence for UDP - enzyme functional but fewer
Criggler najjar - mutation in coding for enzyme itself - all UDPs non functional or minimal activity
Which is dangerous, criggler najjar or gilbert
CN - can cause neonatal death due to unconjugated hype bilirubinemia
Gilbert does not need treatment
Which is dangerous, criggler najjar or gilbert
CN - can cause neonatal death due to unconjugated hype bilirubinemia
Gilbert does not need treatment
Do malaria and severe rhabdomyolysis cause pre, hepatic or post jaundice?
Pre hepatic
What drugs cause intra hepatic jaundice
Isoniazid, rifmapicin
Pyrazinamide (antibiotic)
Paraceetemol overdose
Autoimmune disorders causing intrahepatic jaundice
Primary biliary chooangitis, autoimmune hep
Other causes of hepatic jaundice
Alcohol
NAFLD
Viral hepatitis A-4, CMV, EBV
Leptospirosis - blood infection from animals
Liver malignancy
Wilsons disease
Drugs causing post hepatic jaundice
Co-amoxiclav, flucloxacillin, COCP, HRT, corticosteroids
WHat structural issues can cause post hepatic jaundice?
Gallstones
Surgical strcitures
Biliary atresia
Malignancy = cholangiocarcinoma, extrahepatic malignancy
What type of jaundice does primary sclerosing cholangitis cause?
Post hepatic
How can pregnancy cause jaundice?
Cholestasis - post heoatc
What jaundice do both parasitic infections and pancreatitis cause?
Post hepatic
Blood tests in jaundice
ALT
AST
Bilirubin
GGT
ALP
albumin
Clotting
FBC incl reticulocyte count and blood smear - haemolysis
LDH
Hwo screen for heamolysis in jaundce
Blood smear in FBC
LDH is increased
How does stool and urine appear in pre hepatic jaundice?
Normal
Which jaundice types do urine appear dark and stool pale?
Hepatic and post hepatic
Which type of jaundice is ALP normal in?
Pre
Hepatic and post = raised
Which type of jaundice is ALP normal in?
Pre
Hepatic and post = raised
Which type of jaundice is unconjugated bilirubin normal in?
Post hepatic
What test for in hepatitis serology
ANA
AMA
ASMA
Immunoglobulins
What test for in hepatitis serology
ANA
AMA
ASMA
Immunoglobulins
Viral serology hep A,B,C,E and CMV
Monospot test for EBV
Alpha fetoprotein
Caerolplasmin
Alpha 1 antirypsin
What can cause raised IgM?
Autoimmune disease, OBC, chronic infection
Which immunoglobulin is raised in acute hepatitis?
IgG
How test for CMV
Monospot
What condition is ANA and AMA raised in?
Primary biliary cholangitis
What is ASMA raised in?
Autoimmune hepatitis
What does alpha fetoprotein test for?
hepatocellular carcinoma
How do you test for Wilsons disease?
Caeruloplasmin
What urinary result is suggestive of obstructive jaundice?
Increased urinary bilirubina
Decreased urobilinogen
What urine result is suggestive of hepatocellular failure or increased RBC breakdown?
Increased urinary bilirubin AND urinobiligen
Imaging investigations jaundice
Abdo US
CT abdo
MRCP
Liver biopsy, laporotmy
Imaging investigations jaundice
Abdo US
CT abdo
MRCP
Liver biopsy, laporotmy
What is bilirubin
Breakdown product of haem molecules in red blood cells and other proteins eg myoglobin
What happens to bilirubin in th eliver?
Itws conjugated - excreted in bile
When does birlirubin become soluble?
When its conjugated
What happens to haem moleculaes in the spleen and liver?
Degraded by biliverdin within macrophages to unconjugated bilirubin, bound to plasma albumin and transported to liver
What happens to bilirubin after the liver?
Through liver and cystic ducts in bule, stored in gallbladder or duodenym
Bilirubin is excreted in stool as sterconibilonegne
What happens to conjugated bilirubin that is not excreted?
Rest metabolised by gut flora into urobilinogen - reabsorbed and excreted by kdinedys
Clinical features of jaundice
Fetor hepaticus - sweet breath
Asterixis/hepatic flap
Constructional apraxia
Hypoglycaemia
Bleed and bruising
Hepatomegaly
Ascites
Grading for encephalopathy
0 - no change
1 - decreased awareness and attention, euphoria or anxiety
2 - lethargy, apathy, minimal disorientation, subtle personality change, innaprropriate behaviour
3 - somnolence -> stupor
Responseive - verbal stimuli, confusion, gross disorientation
Complications of liver failure
Cerebral oedema
Hypotension
Hypoglycaenua
Hepatorenal syndrome
Sepsis
Seizures
ARDS
What serum bilirubin suggests acute liver failure
> 300
DAMN drugs
Diuretics
ACEis/ARBs
Metformin
NSAIDs
